1529 Claims Adjudication Jobs - Page 11

About The Role Project Role : Business Analyst Project Role Description : Analyze an organization and design its processes and systems, assessing the business model and its integration with technology. Assess current state, identify customer requirements, and define the future state and/or business solution. Research, gather and synthesize information. Must have skills : Performance Testing Strategy Good to have skills : NA Minimum 3 year(s) of experience is required Educational Qualification : 15 years full time education Summary :As a Business Analyst, you will engage in a variety of tasks that involve analyzing organizational processes and systems. Your typical day will include assessing ...

About The Role Skill required: Talent Development - Learning Operations Designation: Learning Operations Analyst Qualifications: Any Graduation Years of Experience: 3 to 5 years What would you do? Improve workforce performance and productivity, boosts business agility, increases revenue and reduces costsMS Office skills:Ability to understand and make sense of large amounts of data in a complex environment, strong Excel & Word skills, working knowledge of other MS Office Suite (Outlook, PowerPoint & One Note) applications, ability to comprehend and quickly learn client data bases / menu based systems and ability to present data in a comprehensible formatClient Interfacing skills (Email & Phon...

Primary Responsibilities: Be able to implement all the updates of AMA guidelines, AHA guidelines, and CMS guidelines Be able to review and analyze medical records and add/modify CPT codes for minor surgical procedures, vaccines, and laboratory CPT codes as per documentation Be able to extract and code various screening CPT codes and HCPCS codes from the documentation Be able to check NCCI edits and LCD & NCD coverage determinations and modify ICD-10-CM codes, CPT codes, and modifiers accordingly Be an ideal team player who can work in a large group and provide inputs to the team for betterment of the team in terms of quality and productivity Under general supervision, organizes and prioritiz...

About The Role Skill required: Talent Development - Learning Operations Designation: Learning Operations Associate Qualifications: Any Graduation Years of Experience: 1 to 3 years What would you do? Improve workforce performance and productivity, boosts business agility, increases revenue and reduces costsTalent Development processMS Office skills:Ability to understand and make sense of large amounts of data in a complex environment, strong Excel & Word skills, working knowledge of other MS Office Suite (Outlook, PowerPoint & One Note) applications, ability to comprehend and quickly learn client data bases / menu based systems and ability to present data in a comprehensible formatClient Inte...

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management Associate Qualifications: Any Graduation Years of Experience: 1 to 3 years What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating model t...

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years Language - Ability: English(Domestic) - Intermediate What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insu...

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years Language - Ability: English(Domestic) - Intermediate What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insu...

Responsibilities: Regulatory compliance: Ensure that the department complies with industry standards and government regulations Patient and Insurance payments: Follow up with patients who have not paid their bills Financial responsibility: Confirm who is financially responsible for a particular visit Communication: Ensure that all departments communicate effectively Problem-solving: Resolve disputes between staff and balance budgets Interpersonal skills: Use empathy and leadership to manage staff and departments Strategic planning: Implement policies and procedures to improve operations

Bpo Hiring For Health Care Domain Voice Process 6.5 LPA Location Gurugram Only Graduates. No B.E./Btech/UG''s Minimum 1 Year of Voice Experience With International BpO MUST Pls Cal Dipankar @ 9650094552 Email CV @ jobsatsmartsource@gmail.com

Quality Team Lead-Operations Experience Required: Minimum 4.6 years of experience in US Healthcare Claims Adjudication At least 1 year as a SME (on papers) in Claims Adjudication Strong communication and people management skills Key Responsibilities: Supervise, coach, and mentor a team of claims adjudicators/processors. Monitor daily operations to ensure claims are processed accurately and within SLAs. Conduct regular performance reviews, feedback sessions, and skill-building initiatives. Ensure compliance with regulatory guidelines (HIPAA, CMS) and client standards. Conduct root cause analysis (RCA) and implement corrective/preventive actions (CAPA). Work closely with Quality, Training, and...

As a Claims Adjudicator (Medical Claims/Medical Malpractice) at our company, your role will involve reviewing and processing medical claims to ensure accuracy and compliance with regulations and policies. You will also handle claims related to medical malpractice, assessing liability and determining appropriate actions. Your decision-making skills will be crucial as you make informed decisions on claims, considering medical records, policy terms, and relevant laws and regulations. Your qualifications for this role should include at least 6 years of experience in claims adjudication, preferably in the medical or insurance industry. A strong understanding of medical terminology, procedures, an...

TATA AIG General Insurance Company Limited is looking for Deputy Manager - Health Claims to join our dynamic team and embark on a rewarding career journey Assist the Manager in the day-to-day operations of the business, including setting goals, developing strategies, and overseeing the work of team members Take on leadership responsibilities as needed, including managing team members and making decisions in the absence of the Manager Identify and address problems or challenges within the business, and develop and implement solutions Collaborate with other departments and teams to ensure smooth and efficient operations Maintain accurate records and documentation Contribute to the development ...

Retail Claims - Automation & ProjectsKey Responsibilities1 Automate Claims Processes- Design anddevelop automated workflows and business rules to streamline claims processing Integrate with Existing Systems- Integrateautomated claims processing solutions with existing systems and technologies Testing and UAT - Test and validateautomated claims processing solutions to ensure accuracy and efficiency Daily production issue - Troubleshootissues and resolve problems related any day-to-day production issues across allclaim systems for death and health claims5 Collaborate with IT stakeholders, claim team and other requiredstakeholders to understand requirements and implement solutions6 Strong techn...

Bpo Hiring For Health Care Domain Voice Process 6.5 LPA Location Gurugram Only Graduates. No B.E./Btech/UG''s Minimum 1 Year of Voice Experience With International BpO MUST Pls Cal Dipankar @ 9650094552 Email CV @ jobsatsmartsource@gmail.com

Roles and Responsibilities Conduct thorough analysis of insurance claims data to identify trends, patterns, and areas for improvement. Develop and maintain complex reports using SQL queries to track key performance indicators (KPIs) related to claims processing times, costs, etc. Stay up-to-date with industry developments in healthcare payer analytics and adjust business strategies accordingly. Provide expert guidance on claims adjudication processes to internal stakeholders, ensuring compliance with regulatory requirements. Collaborate with cross-functional teams to develop and implement process improvements that enhance claim processing efficiency and accuracy. Desired Candidate Profile 2-...

We are looking for a highly skilled and experienced Clinical Safety Analyst to join our team in the IT Service & Consulting industry. The ideal candidate will have 29 years of experience in clinical safety, preferably in the medical device sector. Roles and Responsibility Conduct thorough analysis of clinical trial data to identify potential safety risks and trends. Develop and implement effective safety protocols and procedures to mitigate identified risks. Collaborate with cross-functional teams, including regulatory affairs, quality assurance, and product development. Review and approve safety-related documentation, such as clinical study reports and investigational reports. Provide train...

Roles and Responsibility Collaborate with cross-functional teams to design and implement solutions for clients in the IT Service & Consulting industry. Provide expert guidance on airlines domain-related projects, ensuring timely completion and high-quality results. Develop and maintain strong relationships with clients, understanding their needs and providing tailored solutions. Conduct thorough analysis of client problems, identifying root causes and implementing effective solutions. Stay up-to-date with industry trends and developments, applying this knowledge to improve client outcomes. Work closely with stakeholders to ensure seamless project execution, meeting deadlines and exceeding ex...

About The Role Skill required: Talent Development - Learning Operations Designation: Learning Operations Analyst Qualifications: Any Graduation Years of Experience: 3 to 5 years What would you do? Improve workforce performance and productivity, boosts business agility, increases revenue and reduces costsTalent Development process.Personal organization to ensure work is monitored and completed in priority order and on time.Data collation / AnalysisDSM / Onshore interactionAbility to work on own InitiativeManage learning solutions, including activities such as registration, vendor management, product support, learning management system.Respond to incoming mail in the Scheduling mailbox and res...

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating mod...

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating mod...

About The Role Skill required: Talent Development - Learning Operations Designation: Learning Operations Analyst Qualifications: Any Graduation Years of Experience: 3 to 5 years What would you do? Improve workforce performance and productivity, boosts business agility, increases revenue and reduces costsTalent Development process.Personal organization to ensure work is monitored and completed in priority order and on time.Data collation / AnalysisDSM / Onshore interactionAbility to work on own InitiativeManage learning solutions, including activities such as registration, vendor management, product support, learning management system.Respond to incoming mail in the Scheduling mailbox and res...

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management Associate Qualifications: Any Graduation Years of Experience: 1 to 3 years What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating model t...

About The Role Skill required: Talent Development - Learning Operations Designation: Learning Operations Associate Qualifications: Any Graduation Years of Experience: 1 to 3 years What would you do? Improve workforce performance and productivity, boosts business agility, increases revenue and reduces costsTalent Development process. Manage learning solutions, including activities such as registration, vendor management, product support, learning management system.Multi-cultural awareness.Passion for customer service.Team player.MS Office skills:Ability to understand and make sense of large amounts of data in a complex environment, strong Excel & Word skills, working knowledge of other MS Off...

Role Objective:To bill out medical accounts with accuracy within defined timelines and reduce rejections for payers.Essential Duties and ResponsibilitiesProcess Accounts accurately basis US medical billing within defined TAT Able to process payer rejection with accuracy within defined TAT. 24*7 Environment, Open for night shifts Good analytical skills and proficiency with MS Word, Excel, and PowerPointQualificationsGraduate in any discipline from a recognized educational institute. Good analytical skills and proficiency with MS Word, Excel, and PowerPoint. Good communication Skills (both written & verbal)Skill SetCandidate should have good healthcare knowledge. Candidate should have knowledg...

R1 India is proud to be recognized amongst Top 25 Best Companies to Work For 2024, by the Great Place to Work Institute. This is our second consecutive recognition on this prestigious Best Workplaces list, building on the Top 50 recognition we achieved in 2023. Our focus on employee wellbeing and inclusion and diversity is demonstrated through prestigious recognitions with R1 India being ranked amongst Best in Healthcare, Top 100 Best Companies for Women by Avtar & Seramount, and amongst Top 10 Best Workplaces in Health & Wellness. We are committed to transform the healthcare industry with our innovative revenue cycle management services. Our goal is to make healthcare work better for all by...